Suicidal behavior and Autism Spectrum Disorder, what are the risk factors? – Case Report

Introduction Autism is a neurodevelopmental disorder characterized by deficits in the ability to initiate and maintain social interaction, as well as a set of restricted and inflexible behavior patterns and interests. Individuals with Autism Spectrum Disorder (ASD) are at increased risk of suicidal behavior, including suicidal ideation, suicide attempts and death by suicide, as compared to the general population. Among the underlying causes, the co-occurrence of other psychiatric disorders, such as depression and anxiety, is common and can contribute to the reduction of the quality of life, as well as a worse prognosis of the disease. Objectives Case report and brief review of risk factors associated with suicidal behavior in individuals with ASD. Methods Review of the patients clinical file; Brief non-sistematic literature review of articles indexed to Pubmed with the key words: “Autism Spectrum Disorder”, “Suicide”, ”Suicidal behaviour”, ”Mood disorder”. Results J., 18 years old, male, with ASD, the best student at school, with above-average results since childhood. Two years ago he showed a non-reciprocal love interest. Since then, he has had multiple visits to the emergency department and successive hospitalizations, mostly because of mood and behaviour alterations, with suicidal ideation. After 1 month with depressive and anxious symptoms, he ended up making a suicide attempt through voluntary intoxication by prescribed medication. He was taken to the emergency room. Examination of mental status highlighted depressed mood, elevated anxiety levels, hypoprosody, and active suicidal ideation. Blood tests and CE-CT scan without changes. He was admitted in the psychiatry ward and treated with fluvoxamine, risperidone and lorazepam. He showed a good evolution of the psychopathological condition. Discharged at day 44, he was referred to a psychiatric and psychological outpatient clinics. Conclusions Mood disorders have a significant impact on the well-being of individuals with ASD, contributing to a worse quality of life and higher suicide mortality. Cognition has been associated with different levels of death by suicide, and individuals with ASD without intellectual disability, such as this patient, are at increased risk of suicide, which may be due to a greater awareness of their own difficulties. The role of genetics has been a subject of interest. The overlap of genes strongly associated with suicidal behavior and ASD has been described. However, there is still need of large scale genetic studies, for a better understanding of the genetic mechanisms involved in this association. The identification of vulnerable individuals and early initiation of preventive and therapeutic strategies is essential to improve the prognosis of ASD. Disclosure of Interest None Declared


Introduction:
The concept of social vulnerability arises in the individual-collective relationship and points to changing social conditions, built on the basis of power relations.In this context, vulnerability can be directly related to the deterioration of social and civil rights, resulting in the weakening of individuals' citizenship.On the other hand, vulnerability can also lead to the deterioration of mental health.Stigma and discrimination generate low self-esteem, decreased self-confidence, reduced motivation, and less hope for the future.
Objectives: This study aimed to explore the perceptions and experiences of vulnerability from the perspective of vulnerable people and identify strategies they used to reduce vulnerability.Methods: This study employed a qualitative descriptive design.Using a purposeful sampling method, data were collected in April 2022.The following criteria were applied in the selection process: (1) adults with a personal sense of vulnerability or the experience of being vulnerable; and (2) understanding the Portuguese language and having reflective capacity.Results: A total of 12 respondents (6 male; 6 women) participated in study, mostly of middle-age.The manifestations of vulnerability reported by participants included being homeless, being a migrant, having an infectious disease, being drug dependent, experiencing a process of loss and grief and living socioeconomic difficulties.The data was summarized in terms of three major themes: (1) Conceptions about vulnerability, (2) Barriers imposed by vulnerability, and (3) Strategies for dealing with vulnerability."Three subthemes were identified within the first theme: ontology condition that spreads, being alone "without network" and being exposed to external pressure (others).In the second theme, there were also three subthemes: discrimination/stigma, difficulties in social reintegration, and "my condition is difficult".Lastly, in the third theme, we found four subthemes: the ability to ask for help/seek support, motivation, and commitment to behavioural change, not exposing others to the same risks, and ignoring the disapproving look of others" (Laranjeira et al., 2022, p.5). Conclusions: Our findings demonstrated that vulnerability is a dynamic process of being exposed to circumstances that influence individual outcomes.However, there is a conceptual gap: vulnerability is regarded negatively, but vulnerability also has the capacity to shift life priorities for the better.Introduction: Autism is a neurodevelopmental disorder characterized by deficits in the ability to initiate and maintain social interaction, as well as a set of restricted and inflexible behavior patterns and interests.Individuals with Autism Spectrum Disorder (ASD) are at increased risk of suicidal behavior, including suicidal ideation, suicide attempts and death by suicide, as compared to the general population.Among the underlying causes, the co-occurrence of other psychiatric disorders, such as depression and anxiety, is common and can contribute to the reduction of the quality of life, as well as a worse prognosis of the disease.Objectives: Case report and brief review of risk factors associated with suicidal behavior in individuals with ASD.Methods: Review of the patients clinical file; Brief non-sistematic literature review of articles indexed to Pubmed with the key words: "Autism Spectrum Disorder", "Suicide", "Suicidal behaviour", "Mood disorder".Results: J., 18 years old, male, with ASD, the best student at school, with above-average results since childhood.Two years ago he showed a non-reciprocal love interest.Since then, he has had multiple visits to the emergency department and successive hospitalizations, mostly because of mood and behaviour alterations, with suicidal ideation.After 1 month with depressive and anxious symptoms, he ended up making a suicide attempt through voluntary intoxication by prescribed medication.He was taken to the emergency room.Examination of mental status highlighted depressed mood, elevated anxiety levels, hypoprosody, and active suicidal ideation.Blood tests and CE-CT scan without changes.He was admitted in the psychiatry ward and treated with fluvoxamine, risperidone and lorazepam.He showed a good evolution of the psychopathological condition.Discharged at day 44, he was referred to a psychiatric and psychological outpatient clinics.Conclusions: Mood disorders have a significant impact on the wellbeing of individuals with ASD, contributing to a worse quality of life and higher suicide mortality.Cognition has been associated with different levels of death by suicide, and individuals with ASD without intellectual disability, such as this patient, are at increased risk of suicide, which may be due to a greater awareness of their own difficulties.The role of genetics has been a subject of interest.The overlap of genes strongly associated with suicidal behavior and ASD has been described.However, there is still need of large scale genetic studies, for a better understanding of the genetic mechanisms involved in this association.The identification of vulnerable individuals and early initiation of preventive and therapeutic strategies is essential to improve the prognosis of ASD.

EPV0704
Introduction: Daydreaming is a normal, very common experience in childhood and adulthood.However, a new phenomenontermed 'Maladaptive Daydreaming (MD)'which takes daydreaming to an extreme form, is currently being investigated.Maladaptive Daydreaming is not listed as an official disorder in the ICD-10 or DSM-5 presently.Objectives: I aimed to review current literature on MD and explore whether there is a possibility for MD to eventually be acknowledged and classified as a real psychiatric disorder.Methods: I gathered information via academic papers found through reliable sites, such as, Ovid, PubMed and Cochrane, and through articles, videos and online forums to gather patients' perspectives.
Results: My research intimated that there is enough information and literature available to create specific criteria to qualify a diagnosis of MD in patients.Possible aetiologies of Maladaptive Daydreaming have been identified.There has also been exploration into treatment options.Conclusions: Overall, I believe there is sufficient evidence for Maladaptive Daydreaming to be classified as an official disorder.Being included in the ICD-10 and DSM-5 would motivate research, expand identification of this disorder in patients, and advance access to help and support for patients.

EPV0707
The effect of Hypnotherapy-based interventions on improving women's experience of pregnancy, childbirth and postpartum: A narrative review Introduction: Hypnotherapy has been increasingly used in recent years in healthcare, with several applications during pregnancy, labor, birth and the postpartum.Objectives: This review was performed to assess the effects of Hypnotherapy before, during and after pregnancy.Methods: A narrative review methodology using keywords determined by the Medical Subject Headings (MeSH) thesaurus was adopted in this study.For this purpose, the databases of PubMed, Scopus,Web of Science, GoogleScholar, and Scientific Information Database (SID) were searched using the keywords of "Hypnosis, Hypnotherapy, Pregnancy, Labor, and Childbirth " from March11 to April 5, 2022; and finally, the related articles published from 2000 to 2022 were retrieved.Results: According to the findings, the effects ofHypnotherapy on pregnancy and delivery and postpartumoutcomes were classified into several categories as the following: Hypnotherapy-based interventions improve childbirth experience, with less anxiety, increased satisfaction, fewer birth interventions, more postnatal well-being and better childbirth experience overall.Hypnotherapy may reduce the overall use of analgesia during labour, but not epidural use.Hypnotherapy intervention during pregnancy aided in reducing physical and psychological symptoms during pregnancy.Conclusions: With reference to the related literature on this subject matter, women can safely pursue hypnotherapy during pregnancy, labor, birth and the postpartum.Hypnotherapy can be presented as a technique enabling patients to have a positive birth experience; however, high quality trials are needed to demonstrate its complete efficacy.